The first decade of continuous monitoring of jugular bulb oxyhemoglobinsaturation: management strategies and clinical outcome.
OBJECTIVE
To comparatively assess outcome of patients undergoing monitoring and management of cerebral extraction of oxygen along with cerebral perfusion pressure vs. outcome of patients undergoing monitoring and management of cerebral perfusion pressure alone in severe acute brain trauma.


METHODS
Prospective, interventional study.


METHODS
Intensive care unit of a university hospital.


METHODS
Adults (n = 353) with severe acute brain trauma. A group of 178 patients underwent continuous monitoring and management of cerebral extraction of oxygen and cerebral perfusion pressure, while a control group of 175 patients underwent monitoring and management of cerebral perfusion pressure only.


METHODS
Routine neuroemergency procedures.


RESULTS
The two groups of patients were matched with regard to age, postresuscitation Glasgow Coma Scale scores, rates of acute surgical intracranial hematomas and brain swelling, pupillary abnormalities, early hypotensive events (before intensive care monitoring), as well as initial levels of intracranial pressure and cerebral perfusion pressure. Outcome at 6 months post injury was significantly better (p < .00005) in the 178 patients undergoing monitoring and management of cerebral extraction of oxygen along with cerebral perfusion pressure, than in the control group of 175 patients undergoing monitoring and management of cerebral perfusion pressure alone.


CONCLUSIONS
In patients with severe acute brain trauma and intracranial hypertension associated with compromised cerebrospinal fluid spaces, monitoring and managing cerebral extraction of oxygen in conjunction with cerebral perfusion pressure result in better outcome than when cerebral perfusion pressure is managed alone.
Cruz
J
J
Department of Neurosurgery, Allegheny University of the Health Sciences, Philadelphia, PA, USA.
D000208:Acute Disease; D000328:Adult; D001921:Brain / Q000378:metabolism; D001930:Brain Injuries / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D002560:Cerebrovascular Circulation; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology; D019586:Intracranial Hypertension / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D007427:Intracranial Pressure; D007601:Jugular Veins; D008991:Monitoring, Physiologic / Q000379:methods; D010101:Oxygen Consumption; D010108:Oxyhemoglobins / Q000032:analysis*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D010108:Oxyhemoglobins